Golfer’s Elbow

What is a Golfer’s Elbow? 

Golfer’s elbow, or medial epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing golf can cause this condition. But several other sports and activities can also put you at risk, especially baseball. 

Golfer’s elbow is pain in the tendons that join the forearm muscles on the inside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain, scarring, and tenderness on the inside of the elbow. Golfer’s elbow is 5x less common than tennis elbow, or lateral epicondylitis, which causes pain on the outside of the elbow. 

Anatomy 

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the inside (medial side) of the elbow is called the medial epicondyle. Muscles, ligaments, and tendons hold the elbow joint together.  

Medial epicondylitis, or golfer’s elbow, involves the muscles and tendons of your forearm. Your forearm muscles flex (bend) and pronate (rotate palm down) your wrist and flex your fingers. Your forearm tendons -- often called flexor-pronator mass -- attach the muscles to bone. They attach on the medial epicondyle.  

Cause 

Overuse 

Recent studies show that golfer’s elbow is often due to damage to a specific forearm muscle. The pronator teres (PT) and flexor carpi radialis (FCR) muscles helps stabilize the wrist when the elbow is bent. When the flexor-pronator mass is weakened from overuse, microscopic tears form in the tendon where it attaches to the medial epicondyle. This leads to scarring and pain. Despite the name of the condition ending in –itis, this is not an inflammatory condition. 

Activities 

Golfers and pitchers are the most common athletes that develop medial epicondylitis. For pitchers, this involves pain usually during the late cocking phase. Athletes are not the only people who get golfer’s elbow. Many people with golfer’s elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle. 

Painters, plumbers, and carpenters are particularly prone to developing golfer’s elbow. Studies have shown that auto workers, cooks, and even butchers get golfer’s elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury, particularly lifting things in a palm up position (supination). 

Age 

Most people who get golfer’s elbow are between the ages of 30 and 50, although anyone can get it if they have the risk factors. In sports like golf, improper grip or stroke technique and improper equipment may be risk factors. 

Unknown 

Medial epicondylitis can occur without any recognized repetitive injury. This occurrence is called "insidious" or “idiopathic”, meaning of an unknown cause. 

Symptoms 

The symptoms of golfer’s elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms. 

Common signs and symptoms of golfer’s elbow include: 

• Pain and tenderness on the inside of your elbow 
• Weakness in hands or wrist 
• Stiffness 
• Numbness or tingling – these can radiate to one or more fingers, usually the ring and little finer 

The symptoms are often worsened with forearm activity, such as swinging a golf club, squeezing or pitching a ball, shaking hands, turning a doorknob, lifting weights (especially biceps curls), picking up something with palm up, or flexing your wrist. Your dominant arm is most often affected; however, both arms can be affected. 

Treatment 

Nonsurgical Treatment - Approximately 80% to 95% of patients have success with nonsurgical treatment. However, at times it can be a frustrating process because it takes on average 9 months for symptoms to improve. Treatment can help shorten the course of symptoms to 4-6 months. 

Rest - The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks. This includes any activities that worsen your symptoms. 

Non-steroidal anti-inflammatory medicines - Drugs like aspirin or ibuprofen unfortunately do not reduce pain because this is not an inflammatory problem. 

Equipment/Form check - Getting your equipment checked for proper fit is crucial. Stiffer clubs often increase the stress on the forearm. One of the best ways to avoid elbow problems is to strengthen your forearm muscles and slow your golf swing so that there will be less shock in the arm when the ball is hit. Having a golf stroke analysis can also identify problems with your mechanics that are leading to injury. 

Stretching - Wrist stretching exercises are done with elbow extended. Do both of these exercises once every hour and hold for 3 seconds each (total of 6 seconds of stretching every hour).